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Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN general practice database in the UK
  1. Kartini Gadroen1,
  2. Caitlin N Dodd1,
  3. Gwen M C Masclee1,
  4. Maria A J de Ridder1,
  5. Daniel Weibel1,
  6. Michael J Mina2,
  7. Bryan T Grenfell3,
  8. Miriam C J M Sturkenboom1,
  9. David A M C van de Vijver4,
  10. Rik L de Swart4
  1. 1 Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
  2. 2 Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Ecology and Evolutionary Biology, Princeton University, Guyot, New Jersey, USA
  4. 4 Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Rik L de Swart; r.deswart{at}


Objective To test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time.

Design A population-based matched cohort study.

Data sources This study examined children aged 1–15 years in The Health Improvement Network UK general practice medical records database. Participants included 2228 patients diagnosed with measles between 1990 and 2014, which were matched on age, sex, general practitioner practice and calendar year with 19 930 children without measles. All controls had received at least one measles vaccination. Children with a history of immune-compromising conditions or with immune-suppressive treatment were excluded.

Primary outcome measures Incidence rate ratio (IRR) of infections, anti-infective prescriptions and all-cause hospitalisations following measles in predetermined periods using multivariate analysis to adjust for confounding variables.

Results In children with measles, the incidence rate for non-measles infectious disease was significantly increased in each time period assessed up to 5 years postmeasles: 43% in the first month (IRR: 1.43; 95% CI 1.22 to 1.68), 22% from month one to the first year (IRR: 1.22; 95% CI 1.14 to 1.31), 10% from year 1 to 2.5 years (IRR: 1.10; 95% CI 1.02 to 1.19) and 15% (IRR: 1.15; 95% CI 1.06 to 1.25) in years 2.5 to 5 years of follow-up. Children with measles were more than three times as likely to receive an anti-infective prescription in the first month and 15%–24% more likely between the first month and 5 years. The rate of hospitalisation in children with measles was increased only in the month following diagnosis but not thereafter (IRR: 2.83; 95% CI 1.72 to 4.67).

Conclusion Following measles, children had increased rates of diagnosed infections, requiring increased prescribing of antimicrobial therapies. This population-based matched cohort study supports the hypothesis that measles has a prolonged impact on host resistance to non-measles infectious diseases.

  • measles
  • immune suppression

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  • DAMCV and RLS contributed equally.

  • KG and CND contributed equally.

  • Contributors Conceived and designed the study: MJM, BG, DAMCvdV and RLDS. Code selection: KG, GMCM, DAMCvdV and RLDS. Data extraction and statistical analysis: CND, GMCM and MdR. Interpretation of data: all authors. Authored draft paper: KG and CND. Critical revisions of manuscript: KG, CND, GMCM, MdR, DAMCvdV, RLDS, MJM and BG. Study supervision: DAMCvdV, RLDS and MCJMS. Obtained funding: none.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the independent THIN Scientific Review Committee (SRC reference number: 15–006).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data from the study are available. All data are contained in the manuscript and the supplementary data files.